MEDICARE: MICHAEL TRENT SCATES PA-C, M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA791	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	970029695	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	40152366	OTHER	TN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1538135314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL TRENT SCATES PA-C, M.S.

Provider Business Mailing Address
First Line	:	117 KENNEDY DR
Second Line	:
City	:	MARTIN
State	:	TN
Zip	:	38237-3309
Country	:	US
Telephone Number	:	731-587-9511
Fax Number	:	731-587-0785

Provider Business Practice Location Address
First Line	:	117 KENNEDY DR
Second Line	:
City	:	MARTIN
State	:	TN
Zip	:	38237-3309
Country	:	US
Telephone Number	:	731-587-9511
Fax Number	:	731-587-0785

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	10/30/2019

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